How the US lags peer nations in health care

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Americans pay more for medical care than citizens of other advanced nations, and get less in return. Our health outcomes are worse. So far as I can tell, enactment of the Affordable Care Act in 2010 hasn’t changed this.

Health care spending per person

United Kingdom, $4,003

France, $4,407

Canada, $4,607

Germany, $5,267

United States, $9,451

Percentage of population without medical insurance

United Kingdom, 0.0%

Canada, 0.0%

France, 0.1%

Germany, 0.2%

United States, 9.1%

What patients pay to see a doctor

United Kingdom, free

Canada, free

Germany, $5 – $11

France, $25, most of which is reimbursed later

United States, $30 to $200, depending on insurance

Number of primary care physicians per 1,000 people

Germany, 4.1

France, 3.1

United Kingdom, 2.8

United States, 2.6

Canada, 2.6

Hospital beds per 1,000 people

Germany, 8.2

France, 6.2

United States, 2.7

United Kingdom, 2.6

Canada, 2.6

Infant deaths in first year per 1,000 live births

France, 3.34

Germany, 3.48

United Kingdom, 4.5

Canada, 4.78

United States, 5.9

Life expectancy at birth

Canada, 81.4

France, 81.0

United Kingdom, 80.1

Germany, 79.8

United States, 78.1

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The four comparison nations don’t all have the same kind of system.

The British National Health Service is like the U.S. Veterans Administration system, except that it covers everybody, not just veterans. The service owns hospitals and clinics and pays salaries to physicians.

Canadian Medicare set the pattern for U.S. Medicare (for the elderly) and Medicaid (for low-income patients). The Canadian provincial governments are single payers who reimburse physicians, hospitals and other health care providers.

Medical care in Germany and France is provided by non-profit sickness associations. Enrollment in sickness associations is compulsory, but they’re all required to provide the same services for the same fees.

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All four foreign systems have financial problems. The cost of medical care is rising in all countries. There are long waits for optional medical procedures in Canada and the United Kingdom. Critics say Germany allows too much unnecessary medical treatment. All four countries have shortages of doctors and nurses, who are paid less than in the United States.

But by most or maybe all measures, all four deliver better medical care at less cost. Administrative costs are less because, in every country, everybody is eligible for the same kind of care at the same cost. The health systems negotiate lower drug prices, which is not attempted in the United States. There are no for-profit insurance companies, standing between the physician and patient and trying to deny reimbursement.

More importantly, all four systems are universal systems. They cover everybody. Unlike in the United States, nobody in Canada, France, Germany or the United Kingdom will die of a curable condition because they couldn’t pay medical bills.